Board of Directors Membership Information

If you would like to request information on becoming a member of the BMIC Board of Directors, please complete and submit the form below.

Please note that the fields marked with an are required.

Name
Company
BMIC Policy Number(s)
Address
Address
City
State
Zip Code
Email Address
Phone
HBA Chapter
Type of Business
Years in Business
Previous Boards served on and/or offices held
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